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Paradoxical enough, it should have been triggered by the country’s doctors who are among the first front-liners in fighting with the pandemic. Instead, that it was headed in a worrying trajectory emerged by chance from them. It aired from within the four walls of the Presidential Secretariat. It was the National Security Council, chaired by President Gotabaya Rajapaksa, that later took the decision. He is one among the ruling alliance leaders who had said a firm “no” to a total countrywide lockdown for fears it would have an adverse impact on the economy. In such exigencies, old measures could come as new ones. It did, under new names.

From May 1 to 14, some 245 persons have died of COVID-19 bringing the death toll to 923. The one thousand mark is not far off. In the same period, there were 29,939 new cases. That was cause for worry. The concern was whether more and more Sri Lankans could be allowed to die for somebody’s good deeds or utter callousness. That it is the agony of Sri Lankans. Even if most are unaware of the truth behind figures or the figures behind the truth, they are aware all is not well. If one needs to learn, all that must be done is to stand in a queue for vaccinations. There, no one is praising anyone. They are all praying they will end up with the jab before stocks end.

Chief of Defence Staff (CDS) and Army Commander, General Shavendra Silva, drove straight from that meeting to Rajagiriya to attend the meeting of the National Operations Centre for the Prevention of Covid-19 Outbreak. There, he announced that “countrywide travel restrictions” would be imposed from 11 p.m. on Thursday till 4 a.m. on Monday. This is whilst engaging in the regular practice of lifting lockdowns on some specific areas and imposing them in other areas. The “travel restrictions,” old wine in a new bottle, were no different to lockdowns where people were expected to remain indoors.

However, there was both traffic and people on the roads. Some braved the inclement weather to stay in queues, snaking their way for more than a kilometre.  An interesting scene played out at a stately office in the midst of a large garden where the second dose of AstraZeneca was being administered. There was a long queue. Suddenly, loud hailer announcement called out names and those concerned broke the queue. By the time other reached, officials said the vaccine was over.

Contrary to expectations, Police checkpoints were few or nonexistent. Even after tomorrow, General Silva has decreed, that people will not be allowed in the streets from 11 p.m. till 4 a.m. The sudden decision also meant a string of ad hoc measures. Apparel factories could function. A government source explained that further steps were under consideration to limit the spread of the pandemic. Wholesalers who brought lorry loads of vegetables to Colombo found the markets closed. They were livid. The Task Force for Economic Recovery advised the public, rather late in the day, to contact district officials if they encountered any problems. There seemed something more worrisome — these measures were all coming through SMS, funnily suggesting a new language of governance.

The immediate challenge for the health authorities is the case of hospitals becoming full. Some of the dedicated COVID-19 hospitals were full on Friday. At the Kalubowila General Hospital, two wards were allotted to treat covid patients and they were full too. In Badulla, Homagama and Kandy, plans were under way to shift an overflow of patients to nearby hospitals. With the overflow situation in mind, more Intermediate Care Centres (ICCs) were coming up.  A decision has also been made to keep the not so serious cases are home. There are no doctors, nursing staff and equipment to class them as fully fledged hospitals.

The current wave of COVID-19 pandemic has assumed greater significance for more than one reason. Firstly, it encompasses an overflow of those affected prompting the need for more and more ICCs. It therefore raises fears over what would follow if these ICCs too become full. Secondly, the recent rise in cases has debunked government claims, oft repeated, of just two or three clusters being the cause for the pandemic. It was proof that there was no transparency. The disease has taken root in the entire country and that has been confirmed by the Epidemiology Unit of the Ministry of Health both through statistics and maps. What does all this mean?

That is the greatest challenge for the ruling alliance. That there is strong public criticism over how the fight against COVID-19 was handled is no secret. It has pushed the public away from the truth. Every week, there are contradictions in the remarks of those in the frontlines. This is not only in respect of rising numbers but also major preventive measures like vaccines. Those who received their AstraZeneca vaccine are waiting for their second dose. They are being told stocks are not available. The fear in the minds of the public has been so intense that crowds do not want to miss the opportunity of vaccinating themselves. The political standing of the government now hinges almost entirely on how it copes with the current pandemic in the coming days and weeks. Of course, this does not mean that the opposition parties are gaining traction. True, Gen. Silva has said that the Army would give its camps to patients and live under trees. He said no patient will be left out. Yet, the previous waves and how they were coped with do not inspire much public confidence.

The precursor to the latest alarm bells to ring was a meeting six Sri Lanka Medical Association (SLMA) specialists with expertise in prevention and management of COVID-19 infection held with President Gotabaya Rajapaksa last Monday. That day he told his ministers about the newly emerging dangers. Here are some of the most noteworthy points they made:

• Number of COVID-19 cases is rapidly and exponentially rising and the number needing ICU care, and deaths related to COVID-19, are speedily escalating. The number requiring oxygen and the number waiting for ICU management are also rapidly rising. There is a severe shortage of PCR facilities, particularly in peripheral hospitals. There are many diagnosed COVID-19 infected individuals languishing at home, awaiting admission to hospitals or intermediate centres. Unless a rapid action plan to reduce the case load is implemented, the health care system will inevitably go out of control and end up in a total breakdown. The possibility of physical and mental fatigue among healthcare professionals is disturbing, and quick action to curtail all the rapid rise of cases is essential to avert a collapse of the healthcare system.
• There is a lag-time of two weeks from the time of infection to develop symptoms and another two weeks for the need for ICU care and even death. As such the death rate seen today is the result of infection contacted one month ago. Based on that perception, it is likely that there will be more and more cases and deaths over the next three to four weeks. Unless action is instituted today, there will be an exponential rise of cases followed by a surge, at which time interventions of any sort is unlikely to have any significant impact on the outbreak.
• The UK variant of COVID-19 is highly transmissible and infectious. As there is a delay in getting PCR reports, by the time the report is available, the infected patient has already spread the disease to a larger community in society.  As such, locking down smaller areas such as Grama Sevaka Divisions is unlikely to be effective in controlling the spread of infection.

The COVID-19 deaths may reach unprecedented levels and grave national catastrophe.

• Despite the hardships encountered by the people, evidence from many countries shows that strict and immediate measures to restrict movement of people is the only measure that quickly and drastically reduces the number of cases.

It is not only the Sri Lankan doctors who expressed concern. Public health experts representing diverse specialties held a ‘brainstorming meeting’ convened by WHO Sri Lanka to discuss the current spike in cases in Sri Lanka, according to a news release. The key observations and recommendations to policy and decision-makers are documented based on proceedings and the consensus reached at the meeting. The views expressed on the situation are those of the experts and do not necessarily reflect those of WHO. Participants included doctors as well as those in the medical profession serving the WHO.

The following crucial factors were considered:

• The COVID-19 situation in Sri Lanka is highly likely to get worse over the next few weeks. The decisions we take NOW will affect the lives of millions of Sri Lankans. Therefore, the next 3-4 weeks are critical in controlling transmission and saving lives.
• The epidemiological trend of the past weeks shows a rapid exponential increase in the number of cases. This trend is likely to continue for some time if no effective intervention is made.
• There is a lag of 1-2 weeks between infection and case detection and a further lag of an additional 2-3 weeks between an increase of reported cases and an increase in reported ICU admissions and deaths. Thus, the deaths and ICU admissions we are seeing now are the consequence of infections that took place at the early stage of this third wave (3-4 weeks ago).
• The public sector health system is stretched to the limit, making it difficult to manage COVID-19 cases and other essential services. More health professionals and preventive staff (e.g. PHIs) are getting infected and HR policies need to be geared to meet the urgency. There is a “tipping point” beyond which the system can rapidly go out of control.
• The more transmissible and severe variants detected in India and other variants have already been detected in Sri Lanka; these can spread faster and may even circumvent vaccine-induced immunity.
• Vaccines will be crucial to controlling the epidemic in the medium-term but will not address the immediate crisis we now face. Some vaccines are only effective after the second dose. Therefore, it will take a minimum of 6-8 weeks to see the effects of vaccination in the number of new cases.

“In the context of the above, there are two URGENT actions we can take to save lives – stop new infections as effectively as possible and prepare for the predictable increase in severe cases and deaths.

“Globally, evidence shows that strict and immediate measures to restrict mobility are the only measures that quickly and drastically reduce cases. Sri Lanka will also benefit from strict mobility restrictions whilst maintaining major economic activities and essential services. There is a need to stop inter-district travel and introduce severe restrictions on non-essential human mobilities and the congregation of people. Universal adherence to ‘precautions’ such as appropriate masking, physical distancing, hand hygiene, and avoiding the 3Cs — crowds, confined and enclosed spaces, and close-contact settings– is a must. High transmission areas must be shut down for 2-3 weeks to stop or limit transmission. There should be a national mobilisation effort to accelerate vaccination.

“Reconsider the management of asymptomatic cases, revise clinical management protocol to include home management.  Increase focus on intermediate care centers to detect cases early, properly monitor patients, and appropriately manage cases, thereby minimising the need for more intensive care. Prepare for an increase in hospitalisation and the need for adequate HDU and ICU care.”

This brings one to a modelling app of a British company which the Health Ministry’s Epidemiology Unit has been using since the outbreak of COVID-19. A recent copy seen by the Sunday Times makes some interesting observations.

The period from November 20 last year to February 21 this year reflects a steady increase in the number of new infected persons a day, on average. March data appears corrupt as the February 21 total — 19,085 — and April 21 total – 15,440 cases — compared with March 21 total – 9,463. If the data is not corrupt, then the testing conducted during March must have been reduced to less than 50 per cent compared to other previous and preceding months. The knock-on effect of incomplete March data distorts April 21 data too.

The average per day new cases has been: November 2020 – 582, December 2020 – 608, January 2021 – 682, February 2021 – 668, March 2021 – 305 and April 2021 515. Some of the revelations that arise from this position are:

• The first 12 days of May this year, on average per day, the number of cases had increased to 2,115 per day.
• The model prediction is that this per-day average is going to go past 3,000 in the coming days.
• The model has predicted a steady increase of cases since the beginning of April and beyond May.
• By and large, the model prediction for daily cases from April 4, this year to May 12 this year has been fairly accurate.
• Up to 6 a.m. on May 13, 75 percent of the total infected cases have been from seven districts — Colombo, Gampaha, Kalutara, Kandy, Kurunegala, Galle and Ratnapura.
• Outside these seven districts, the rest of the country data is so varied and materially lower over the past months and this is believed to be due to the much less testing that is taking place in the rest of the country. If this assumption is proven right, then the numbers reflected as new cases, and total cases by region/district and country is extremely understated.
• Within the rapidly increasing daily infection figure, large portion of the patients have been critically infected rather than severely infected. However, the severely infected number has remained steady and the marginally increasing number compared to the critically infected number has been increasing materially.

This situation raises more questions than it answers. Most important is what special measures were taken, if any, when the model prediction has been proven right for past many weeks, especially when the prediction suggests the daily cases to be over 3,000 by May 13. What is the short/medium term map for recovery? What are the testing statistics by districts and by day/week/months? Why did the government not lock down the seven districts earlier and why is it not doing so now? Should not a team of experts lead the crisis management? Also, should not the government hire the services of retired nurses and medical personnel to help in exigencies like in the UK?

As pointed out earlier, both the conduct of the preventive measures for COVID-19 and the dissemination of information at present emanate from the government. Even if most are true for purposes of argument, the spin in others has remained misleading. For well over one year during the pandemic, the main opposition has not been able to play any constructive role so far. Once, Samagi Jana Balavegaya leader, Sajith Premadasa declared publicly that they would support the government in its endeavours to fight COVID-19. He invited Colombo-based diplomats for meetings and appealed for assistance – the same task undertaken by Foreign Minister Dinesh Gunawardena. However, a more nuanced appeal was made by UNP leader and former Prime Minister Ranil Wickremesinghe. He declared that the Cabinet of Ministers should take over the task to direct and control the COVID-19 battle. There are senior ministers who share this view but are reluctant to speak out openly.

“The government is mixing up its priorities. It should first focus on fighting the pandemic and then direct its energies to re-build the economy,” declared Anura Kumara Dissanayake, leader of the Janatha Vimukthi Peramuna (JVP). He told the Sunday Times, “More and more people are falling victims to COVID-19. This government has two former Presidents – Mahinda Rajapaksa and Maithripala Sirisena. What is desperately needed is the political leadership to fight the epidemic. It is only a nation of strong people which could build a robust economy,” he said.

Rajitha Senaratne, a former Health Minister, declared, “One of the main issues with the government in controlling the COVID-19 situation is the failure to take the correct decision at the right time. Even the lockdown was the same.  We provided advance warnings about the situation.

“The vaccination programme is another area where the government had delayed.  We have been asking the government to prepare. It failed to grant approval in time and place the orders.  We not only don’t have the vaccines, but also, we are paying more for the vaccines now. Another key issue in controlling the COVID-19 situation is that the health officials who are specialised in the subject do not have a say and the decisions are being taken by persons who have a military background. Even now the government should hand over the decision-making process to those who are specialists in the subject. The government claims it does not have an issue in providing oxygen, but now it says it needs more cylinders and faces transportation issues. This is another area where the government faces an issue.”

Media Minister Keheliya Rambukwella, however, declared that “we are in the process of controlling the situation. He told the Sunday Times, “There is no alternative other than vaccinating 60 to 70 percent of the population. Therefore, we are getting down the vaccines and going ahead with the mass vaccination programme. We do not have an issue in getting down vaccine. We will even pay double the amount to get the vaccines for the people.

“However, the people too should keep in mind that they have a major role to play in keeping the situation under control.  Even the short lockdown introduced over the long weekend has been opposed by some and some were complaining that their businesses will be affected. We need the cooperation of the public. We deny opposition claims that we do not have control of the situation. Some are blaming us that we have failed to provide the vaccines to the people in Kandy. We will be doing that too shortly.”

The campaign against the pandemic is not the only priority for the government this week. It is also keen to ensure that the Colombo Port City Economic Commission Bill is passed in Parliament. The government has not paid heed to a call by the JVP to delay passage of the legislation until the COVID-19 pandemic eases. JVP leader Dissanayake said we made this appeal during the party leader’s meeting but our call was not accepted.

Speaker Mahinda Yapa Abeywardena will on May 18 (Tuesday) disclose the ruling of the Supreme Court in Parliament. Government sources said that amendments for the Bill would be made but declined to reveal details. Thus, the Colombo Port City will receive its legal teeth this month as the government redoubles its efforts to overcome its biggest political threat – surmounting the pandemic. That, to say it mildly, is a do-or-die battle. The reputation of the government and people’s lives are at stake. One cannot supersede the other.